Colorado Revised Statutes Title 10. Insurance § 10-16-1303. Definitions

(3)(a) “Equivalent rate” means, for a hospital that is part of a pediatric specialty hospital system where over ninety percent of the hospital system's population served is under eighteen years of age and that has a level one pediatric trauma center, the payment rate determined by the medicaid fee schedule for the hospital from the most recent year for which a complete set of hospital financial data is publicly available as of May 10, 2023, multiplied by a conversion factor equal to the ratio of the statewide payment-to-cost ratio for medicare to the hospital's specific payment-to-cost ratio for the most recent set of publicly available hospital financial data as of May 10, 2023, which is 1.52.

(b) In any given year, the rate in subsection (3)(a) of this section must be adjusted annually for cumulative inflation by a factor equal to the average percentage increase in the medicare inpatient and outpatient prospective payment systems over the previous three years.

(c) For any health-care service without an existing medicare reimbursement rate and for services that have low volume statewide relative to other medicare services, including pediatric or obstetric services, an equivalent rate means a rate set by rule of the commissioner after consultation with a statewide association of hospitals, physicians, other providers, and the department of health care policy and financing. The equivalent rate must utilize the ratio of medicaid payment rates to existing medicare payment rates whenever possible.

(11)(a) “Medicare reimbursement rate” means the facility-specific reimbursement rate for a particular health-care service provided under the “Health Insurance for the Aged Act”, Title XVIII of the federal “Social Security Act”, 42 U.S.C. sec. 1395 et seq., as amended.

(b) For a hospital that is reimbursed through the medicare prospective payments systems rate for a critical access hospital, “medicare reimbursement rate” means the rate based on allowable costs as reported in medicare cost reports and the historical cost-to-charge ratios for the specific hospital.